IBS and awful mornings, every morning.

[Bluespecs]

I have suffered with IBS (mixed, mainly loose with constipation a few times per month), for almost 30 years.

The first 6 years were dreadful then it settled to a predictable pattern in my 30's (actually disappeared when pregnant at 32) but since my mid 40's it has been dreadful.

I am now 52. As things had got worse since the age of 45 I've had 2 colonoscopies, a gastroscope, a pill camera endoscopy and bile acid malabsorption scan. All during the last 5 years.

'Just' IBS and functional dyspepsia according to my gastro and she appears no longer interested.

I avoid my triggers foods, only drink water, I exercise, meditate every night before bed and listen to gut directed hypnotherapy yet I have symptoms every single day.

The worst thing for me are the mornings. As soon as I wake I have to go to the loo quick. Some times it's loose, some times it's slightly constipation but often it's fairly normal yet the urgency is there regardless and even when I've finished I feel as though I still need to go. My digestive system will gurgle and growl all morning, regardless if I eat or don't. I will often need to go again an hour or so later and sometimes again during the day but 80% of the time, come the evenings, it all settles only to start up again as soon as I wake.

I actually dread waking up now as I know what my morning will consist of and it makes living a 'normal' life difficult. There is nothing worse than leaving the house with that incomplete feeling. I am fortunate that atm I am not working (I have other health issues including endometriosis and am deep in perimenopause atm which is a whole other issue) but I do have to take my DD to college three mornings a week and often have to rush back home because sitting in rush hour traffic has set things off again.

I do acknowledge that I have an unhealthy obsession with my bowels and a huge fear of needing the toilet wherever I go and that stress in itself is not helping but nothing I do to help actually helps. I am even under a neuro-gastroenterologist in London but none of their strategies are helping me.

I long to feel normal, I hate that I long to get every day to whizz by so I can get to the evenings when everything settles. That's pretty miserable.

Has anyone else struggled with anything like this? I feel I've tried every diet, eliminated every trigger food, tried every prescribed and off the shelf medication but it's just getting worse the older I get.

It's miserable being held hostage by your bowels every day.

This pattern is fairly common with IBS unfortunately, it even has a nickname "the morning rush". When you get the constipation side of things what style of constipation do you have, is it the type where you actually don't go at all for a few days or is it the type were you're passing small amounts and straining for your life? The reason I'm asking is because if it's the latter kind then a friend of mine had success with taking a half or one imodium every night before bed this seemed to slow things in the morning so she could still go to the loo but without the rush and looseness. However if you have typical "not going at all" style constipation then I don't think this would work for you. If you did give it a try I would suggest combining this method with a high fibre style medication during the day such as fybogel to bulk up the stool.

I have IBS also but not to the extent you have. Have you tried finishing eating earlier in the day, does that help?

When I am constipated it's more that I keep going several times a day but it's pebbly/small amounts. I hardly ever miss a day of going to the loo. I have no idea why I suddenly change like this for a few days a month but it's always been like this and usually mid cycle so I suspect it's hormonal.

I have to be careful with Imodium as too much will stop me from going then I end up with an awful tummy ache and inevitably I will then end up with an overflow situation. I do take it occasionally when things are bad but I find peppermint oil capsules work better.

I have experimented with lots of different fibres over the years both via food and otherwise but they all exacerbate my ibs-d. Having mixed IBS is really hard work as I can never find a routine which works for both the ibs-d and c. My gastro has admitted that it's the hardest sub type to control.

I usually stop eating anything around 6-7pm. I find if I stop any earlier then my tummy rumbles so badly when I lay down at night which can keep me awake, or it wakes me around 3am!

Sorry I’ve no useful advice or coping strategies, but you have my utmost sympathy. I’m just slowly re-introducing foods that I eliminated for months of low-FODMAP.
I completely understand the morning urgency, usually loose, then knowing there will be more emptying needed, possibly several times, before I dare leave the house. Every outing is planned around availability of toilet facilities and I take extra tissues and bags on long dog walks in case I need to dash into the woods. I’m 70 next year and I don’t want to poo in the woods.

I hope you have a better day.

When I am constipated it's more that I keep going several times a day but it's pebbly/small amounts. I hardly ever miss a day of going to the loo. I have no idea why I suddenly change like this for a few days a month but it's always been like this and usually mid cycle so I suspect it's hormonal.

I was just going to say - Hormones! My gastroenterologist agreed it is the likely cause of my IBS which only started in peri, but I always had gut issues around my period. I'm in agony every day as also have daily period! My gynae suggested putting me into menopause with gonadotropin injections which will cease all womb activity basically to see if it helps. Said the womb is a highly inflammatory organ. Incidentally women on HRT are twice as likely to develop IBS. I have to have a hysteroscopy first. Sympathies, I wish I knew the answer.

Have you ever had an early morning cortisol blood test? I had a very long history of almost exactly the same symptoms as you and eventually I was diagnosed with Addisons disease - which is very rare, but a lot of people have a degree of adrenal insufficiency which is only picked up by a blood test (it needs to be done between 8-9am and won’t have been done as part of standard bloods). If it comes back under 300 you should be referred to endocrinology for an sst test (you can google this if you wish). Diarrhoea - particularly morning type as you describe - is one of the main symptoms.

One of the other things that’s really helped me is amitriptyline. Lots of people with ibs type d have huge success with this at a very low dose - I only take 10mg at night. I wish I had started it 20 years ago…!

Hi op. So sorry you are having to deal with this. 💐

The key here surely is hormones?

(The fact that your IBS disappeared when you were pregnant would indicate that anyway?)

I am not a doctor but I believe prostaglandins loosen the bowel every month when we have our period?
https://health.clevelandclinic.org/why-do-you-poop-more-on-your-period

Also the fact that endo is implicated, which can exacerbate IBS, would also indicate a gynae connection?

My experience with this is that I had absolutely awful IBS every morning for years and years. It got so bad that I would throw up too, and latterly, I kept a bucket by my bed. It really ruined my life for years but at the same time it became my life! Travelling anyway or attending early appointments was a nightmare.

Anyway, separately to this, after years of very painful periods too, it was discovered that I had two fibroids the size of clementines: one of which was embedded in the uterus wall, plus one ovarian cyst which was the size of a small melon by the time they operated.

Throughout all of this time, I constantly asked my gp, my gynaecologist, my gastrointestinal consultant; if gynaecological issues can have an adverse effect on the bowel, and the answer came back a resounding “no”.

Anyway, guess what happened when my ovarian cysts and fibroids grew so big that I finally had to have a hysterectomy? I never had IBS issues again! It cleared up overnight! And those same doctors are still saying that there is no connection between the bowel and the womb! I did have a very strange heart shaped backwards sloping womb though, so maybe that had something to do with it?

Anyway, from the very moment I woke up, all bowel symptoms disappeared and it has been so liberating! I remember thinking that my guts felt immediately different and better even while I was coming around from the anaesthetic!

Obviously this is only some random advice on the internet, which worked for me, and I can’t guarantee that it will work for you op, and all serious operations carry risks etc. However, I have a feeling it might work for you because I felt the healthiest I ever felt during my two pregnancies. It’s maybe something worth exploring anyway! Good luck!

I've never heard that said about the womb being an inflammatory organ but it makes sense to me; my IBS issues are not as bad now that I'm post menopausal (no HRT).

Yes, my GP was adamant it wasn't hormone related and I had an MRI and colonoscopy, all normal. It was the gastro specialist, who was actually doing a UK wide study on IBS in women who agreed with me that it was likely my hormones. I almost cried with relief that I'd finally been heard. Haven't got a resolution yet but hoping to have the injections after my hysteroscopy. Mine actually started when I started on HRT which I can no longer take.

Menopause makes it even worse IME. I still work part time partly because of it. I eat early too, sometimes have my tea at 17;30. Never snack in the evening, always active and healthy.
You have my sympathies.

It wouldn't surprise me if you had bowel endometriosis.

The womb and bowel are all nestled together and the research on how bowel conditions affect women is unsurprisingly limited (because most medical research is only conducted on men), so unfortunately sometimes medics can be less than well informed about how to care for women.

https://www.endometriosis-uk.org/endometriosis-and-bowel

I feel your pain. I do the same on my dog walks too.
I hope the re-introducing of the fodmap goes ok.

My gynae has suggested those injections too but I'm holding out for a hysterectomy. I have the endometriosis but also adenomyosis and a failed uterine ablation from 3 years ago. I'm hoping a hysterectomy may help in some ways.

I hope it all goes well for you.

I have often wondered if I have cortisol issues. My friend has Addison's.
I had a CT scan a few years back as I have a large kidney cyst. One of the incidental finding were a few very small nodules on my adrenal glands. My urologist wasn't concerned but I do often worry about that.

I agree with this totally.

I am sure the combination of perimenopause and my endometriosis has greatly flared up my digestive issues.

I also have the additional issue of adenomyosis which was caused by my, then undiagnosed endo being pushed into the walls of my uterus by a uterine ablation procedure. I asked my endo gynae if my bowel issues could be caused by the endo and he rudely waved his hand in my face and told me there was no connection and he wasn't going to discuss that (he's a very rude man).

I'm on a waiting list for a hysterectomy, not looking forward to it, petrified in fact but if it were to 'cure' my IBS that would be a miracle.

I really wish my endo gynae was onboard with this. He won't even discuss my digestive issues.

That is very unusual and if I were you I’d definitely push for the cortisol test. It’s an easy thing to rule out as unlike many other conditions it is very black and white based on the results - you either have it or you don’t. It’s not diagnosed based on anything other than the results of a test.

I asked my endo gynae if my bowel issues could be caused by the endo and he rudely waved his hand in my face and told me there was no connection and he wasn't going to discuss that (he's a very rude man).

Sadly that doesn't surprise me. I know of women who've had proctectomy surgery and a) not been warned about the gynaecological impact and b) when they had predictable gynaecological consequences been faced with mystified consultants who knew nothing about it because all the literature they had only considers side effects for male patients. Or like yours, their consultants were dismissive.

(Proctectomy removes the rectum - which contributes to supporting the vagina and uterus. When that support is removed, dysfunction can ensue, such as problems with periods.)

Have you tried asking for a second opinion? It's not a strict legal right but the NHS will usually honour such requests. Your consultant sounds crap, frankly. I feel like you're being let down.

If you have adenomyosis too that just makes it seem even more likely that your gynae issues are involved in your bowel issues.

I have this every morning. Have done for a few years.....first thing i do from waking.
I find the days im in the office or have something planned for a weekend day im worse...... possible nerves.
Its definitely not related to food for me. Its just a woosh effect i get as soon as i stirr.

I do have IBS, had it for 20yrs due to food poisening........later on developed lactose intolerance........bloody nightmare

I’m terribly sorry that your gynaecologist treated you so rudely. That’s so unprofessional and dismissive. And this lack of a holistic approach in 2025 is so blinkered!
And the lack of research material on female bodies makes me livid!

If it’s any consolation op, please try not to be scared of having a hysterectomy. For me, it was the best thing I have ever done. My operation wasn’t in uk but surgical techniques and anaesthetics have come on a lot in the past couple of decades. I had my womb and ovaries removed by keyhole survey through my vagina (sorry for tmi) which means that although it’s a big op, the recovery is much quicker than when they have to cut you open. But even then, techniques have improved massively since our mothers’ generation.

I felt substantially fine, if a bit tired, four days post op, and although you have to be careful and not over do it, my recovery was very straightforward.

Where I live, I also have access to pelvic floor physios and about eight to twelve weeks post-op it was recommended that I take a course of exercises to re-educate my body and get all the organs in to their new positions to fall in to the correct places as it were!

I am waiting for the next appointment with the gynae, I am going to see how he is. I had an appointment a few months ago and he was so very rude and dismissive, if he is as rude as last time I will contact PALS and see if I can see someone else.

The whoosh sensation is exactly what I get. As soon as I wake up and my brain switches on it feels as though my digestive system kick starts and goes straight on to turbo setting.

Thank you. I think I will have no choice but to go for the hysterectomy as my uterus is completely ruined by the uterine ablation (my biggest regret ever) and the adenomyosis. I worry now that if I were to have any worrying post menopausal bleeds it wouldn't show because of the ablation so I would rather it came out. I would hopefully opt for keyhole but it's the thought of going under terrifies me the most.

Hi again Bluespecs

I strongly suggest that you have a talk with the anaesthesiologist when you have your pre-op talk and make it very clear how terrified you are of going under. They are very used to handling these fears and talking you through it. They want it go smoothly for them too! My gynaecologist’s anaesthesiologist was very kind when I spoke to her beforehand and they gave me half a diazepam half an hour before being rolled down to surgery, which took the edge off! Please do not suffer in silence!